Respiratory Exam 1

Question 1

conducting air ways

Answer 1

rigid tubes that transport air while warming, humidifying, and purifying
nasal cavities to terminal bronchioles

Question 2

air reaching the lungs is what

Answer 2

fully humidified, near body temp, relatively free of living and nonliving matter

Question 3

respiratory air ways

Answer 3

spongy respiratory tissue that facilitates gas exchange
respiratory bronchioles to alveolar ducts to alveolar sacs to alveoli

Question 4

nasal cavity

Answer 4

hollow organ composed of bone, cartilage, and connective tissue covered by mucous membrane

Question 5

paired nasal cavity chambers are separated by what

Answer 5

bony and cartilagenous nasal septum

Question 6

wide nasal cavity base rests on what

Answer 6

hard and soft palate

Question 7

narrow nasal cavity apex points toward what

Answer 7

anterior cranial fossa

Question 8

each nasal cavity communivates with what

Answer 8

anterior - external environment through anterior nares
posteriorly - nasopharynx through chonae
laterally - paranasal sinuses and nasolacrimal duct

Question 9

nasal vestibule

Answer 9

dilated space just inside nostrils lined by skin

Question 10

inferior 2/3 of nasal cavity lined by what

Answer 10

respiratory mucosa

Question 11

olfactory region

Answer 11

located at apex (upper 1/3) of each nasal cavity
lined by specialized olfactory mucosa

Question 12

respiratory epithelium

Answer 12

pseudostratified ciliated columnar epithelium with golblet cells
associated with parts of conducting portion

Question 13

cilia do what

Answer 13

act as a filter
beat toward oropharync to carry mucus and foreign matter to be swallowed

Question 14

goblet cells

Answer 14

produce mucus which binds to debris and keeps the membrane moist

Question 15

brush cells

Answer 15

columnar cells with blunt apical microvilli
chemosensory receptors - synapse with sensory neurons (olfactory neurons)

Question 16

small granule cells (Kulchitsky cells)

Answer 16

dense core granules
part of diffuse neuroendocrine system (DNES)

Question 17

basal cells

Answer 17

stem cells
lie on basement membrane and have no contact with epithelial surface

Question 18

lamina propria

Answer 18

loose connective tissue
deep to epithelium lining nasal cavity
continues through respiratory system ending before structures involved in gas exchange

Question 19

seromucous glands

Answer 19

in lamina propria
provide moisture and mucus
also find lymphocytes, plasma cells, macrophages, and collections of lymphatic tissue in lamina propria

Question 20

large venous plexi

Answer 20

in lamina propria
warms the air
can engorge and produce stuffy feeling

Question 21

olfactory epithelium

Answer 21

on rood and superior conchae of nasal cavity
pseudostratified columnar epithelium without goblet cells

Question 22

paranasal sinuses

Answer 22

mucousal surface lined by low pseudostratified ciliated columnar epithelium with goblet cells
ethmoid, frontal, sphenoid, maxillary
lamina propria thin and continuous with underlying periosteum
can be site of secondary bacterial infect after upper respiratory viral infect

Question 23

dainage openings of paranasal sinusesnasopharynx

Answer 23

into nasal cavity
can become occluded if mucosa inflamed or swollen
mucus can occumulate building pressure

Question 24

nasopharynx

Answer 24

covered with pseudostratified columnar epithelium with goblet cells (some stratified squamous epithelium)
pharyngeal tonsils (adenoids)
palatal muscles cause occlusion during swallowing or blowing

Question 25

oropharynx

Answer 25

continuous with nasopharynx leading to oral cavity stratified squamous epithelium

Question 26

larynx

Answer 26

begins with epiglottis ends at trachea connects pharynx to trachea walls have hyalin and elastic cartilage, connective tissue, striated muscle internal surface covered by mucous membrane w glands

Question 27

epiglottis

Answer 27

superior anterior portion of larync project upward and backward when swallowing to divert food to esophagus supported by elastic cartilage most stratifies squamous (not inferior portion of posterior)

Question 28

beyond. the epiglottis

Answer 28

respiratory epithelium begins at base of epiglottis and continues down larynx remainder of laryngeal cartilages made of hyaline cartilage

Question 29

mucosa of true vocal cords

Answer 29

stratified squamous epithelium

Question 30

glottis

Answer 30

opening of true vocal cords close to prevent aspiration when swallowing and to increase abdominal pressure in cough/vomiting

Question 31

trachea

Answer 31

conduit for air assist in climatization of inspired air larynx to middle of thorax in front of and adjacent to esophagus divide into right and left primary bronchi

Question 32

trachea and main bronchi epithelium

Answer 32

pseudostratified ciliated columnar with goblet cells cilia propel mucus blanket out gland cells (goblet cells) produce mucus poorly differentiated basal cells (stem cells)

Question 33

mucus

Answer 33

blanket of mucus from trachia to larger bronchioles high viscosity but lies on hypophase layer of lower viscosity beneath cilia lets cilia beat hypophasic layer sticky surface layer containing foreign particles flow up airway as continuous sheet can block gas exchange so production decreases as approaching conduction zones

Question 34

branching

Answer 34

trachea branch into two primary bronchi then 23 generations of branching to end of airway epithelium thins and simplifies number and deposition of gland cells change

Question 35

lamina propria of trachea and main bronchi

Answer 35

irregular fibroelastic connective tissue with seromucous glands and lymphoid elements

Question 36

cartilage of trachea and main bronchi

Answer 36

"C" shaped hyaline cartilage rings keep trachea and extrapulmonary portion of primary bronchi open smooth muscle and connective tissue posteriorly adjacent rings connected by fibroelastic connective tissues

Question 37

intrapulmonary bronchi

Answer 37

branch many times causing decrease in diameter respiratory epithelium cartilage as irregular plates, some circular that surround bronchi and keep them open cylindrical smooth muscle spirals around elastic fibers intermixed

Question 38

conducting portion

Answer 38

as branching occurs and diameter decreases each component of the wall gets thinner (except smooth muscle)

Question 39

bronchioles

Answer 39

larger have simple ciliated columnar epithelium with few goblet cells smaller have simple cuboid ciliated epithelium with no goblet cells

Question 40

club cells

Answer 40

(aka Clara cells) replace goblet cells in bronchioles bulging domes of apical cytoplasm that contains granules secretes low viscosity non mucinous proteins and phospholipids (contribute to surfactant) progenitor cells regenerate bronchiolar epithelium detoxify

Question 41

respiratory bronchioles

Answer 41

alveoli present as outpuchings simple cuboical epithelium with cilia smooth muscle spirals ensheathed in connective tissue

Question 42

alveolar ducts

Answer 42

thin walled branching tubes with simple squamous epithelium numerous alveoli and alveolar sacs open into ducts between alveoli the wall is supported by fibroelastic connective tu=issue and spiraling smooth muscle

Question 43

alveolar sac

Answer 43

cluster of alveoli thin walled polyhedral sacs

Question 44

alveoli

Answer 44

pure respiratory surface smooth muscle absent fibroelastic connective tissue present closely packed, walls not separate but make interalveolar septa small alveolar pores (of Kohn) allow air pressure to equilibriate and circulate between alveoli reticular fibers and some elastic fibers support simple squamous epithelium

Question 45

type I cells

Answer 45

very thin shape changes with degree of alveolar inflation 97% surface area of alveoli

Question 46

type II cells

Answer 46

aka septal cells bulge into alveolar lumen between type I cells contain lamellar bodies composed of surfactant to reduce surface tension and prevent collapse

Question 47

alveolar phagocytes

Answer 47

dust cells migrate into alveoli and engulf debris

Question 48

blood separated from air by

Answer 48

endothelial cell basal lamina of endothelial cell fused with basal lamina of type I pneumocyte simple squamous alveolar lining (type I cell)

Question 49

mesothelioma

Answer 49

malignant cancer of lining of pleura or peritoneum epitheloid type mesothelioma often associated with asbestos exposure usually squamous mesothelial lining altered to cuboid or columnar epithelial cells

Question 50

blood supply to alveolar lining

Answer 50

bronchial arteries supply oxygenated blood to thicker walled bronchi, these arteries extend down toward most peripheral bronchi and some into pleura pulmonary veins carry returning blood from both of these systems back to heart vessels supplied by autonomic nervous system

Question 51

lung cancer

Answer 51

squamous cell - smoking, arise from epithelial cells of segmental bronchi adenocarcinoma - nonsmokers, epithelial cells more peripherally small cell carcinoma - high malignant, neoplastic transformation of kulchitsky cells in bronchial respiratory epithelium

Question 52

development of respiratory system begins when

Answer 52

day 24-26

Question 53

how does respiratory development begin

Answer 53

formation fo smal laryngeotracheal groove in ventral midline at lower end of pharynx

Question 54

laryngotracheal groove does what

Answer 54

grows down and deepens to form pouch like laryngotracheal diverticulum then becomes fully open to foregut forming a new tube (laryngotracheal tube)

Question 55

communication with the foregut is maintained via what

Answer 55

laryngeal orifice (longitudinally oriented slit like opening)

Question 56

embryonic phase swellings

Answer 56

week 3-7 proliferation of mesenchyme forms swellings around laryngeal orifice (epiglottal and arytenoid swellings) from these epiglottis, glottis, laryngeal cartilage, and musculature will develop

Question 57

embryonic phase laryngotracheal tube

Answer 57

elongates downward and penetrates underlying splanchnopleuric mesoderm

Question 58

epithelium of respiratory system derived from

Answer 58

endoderm

Question 59

development of larynx

Answer 59

laryngeal opening temporarily closed off by growth of laryngeal epithelium recanalization gives rise to vocal cords

Question 59

surrounding cartilagenous and muscular tissue derived from

Answer 59

splanchnic mesoderm

Question 60

mesenchyme of the larynx is developed from what pharyngeal arches

Answer 60

4th and 6th

Question 61

mesenchyme of larynx innervated by what

Answer 61

vagus nerve

Question 62

distal portion of laryngotracheal tube develops what

Answer 62

trachea and lungs trachea becomes filled in by cell proliferation then recanalization to become lined by endoderm

Question 63

trachoesophageal fistula

Answer 63

abdnormal connection between trachea and esophagus component of VACTERL association (vertebral anomalies, anal atresia, cardiac defects, tracheoesophageal fistula, esophagus atresia, renal anomalies, limb defects)

Question 64

lateral mesoderm splits and folds laterally causing what

Answer 64

space between somatic and splanchnic mesoderm layers called intraembryonic coelom

Question 65

primary mesentery does what

Answer 65

suspend gut from dorsal body as dorsal mesentery and attach it to ventral body wall as ventral mesentery this divides coelem into right and left

Question 66

epithelium of internal lining of larynx, trachea, bronchi, lungs

Answer 66

endoderm origin

Question 67

cartilagenous, muscular, connective tissue derived from

Answer 67

visceral splanchnic mesoderm

Question 68

lung development

Answer 68

during septation from foregut lung bud forms trachea and 2 lateral oupocketings (future primary bronchial buds) at 5th week these enlarge into right and left primary bronchi right forms 3 secondary bronchi and left forms 2

Question 69

pleural cavities

Answer 69

lungs grow into narrow pericardioperitoneal canals on each side of foregut these seperate from peritoneal and pericardial cavities by pleruoperitoneal and pleuropericardial folds visceral mesoderm covering lungs become visceral pleura, somatic mesoderm lining body wall forms parietal pleura

Question 70

diaphragm

Answer 70

caudal ends of pleural canals the pleuroperitoneal folds fuse w the septum transversum and mesentary of esophagus making the bulk of the diaphragm myoblasts from cervical segments (C3-C5) migrate into body wall mesenchyme becoming 3rd component of diaphragm forming thin ring of tissue along dorsolateral borders

Question 71

embryonic stage

Answer 71

week 3-7 trachea forms major airways begin to appear

Question 72

pseudoglandular stage

Answer 72

week 5-16 no gas exchange zones lung resembles exocrine gland late - proximal airways well developed and differentiated, epithelium ciliated and cartilage seen

Question 73

canalicular stage

Answer 73

week 16-26 terminal bronchioles enlarge and branch respiratory bronchioles then 3-6 alveolar ducts appear terminal sacs begin to form vascularization - caudal slower than cranial

Question 74

terminal sac stage

Answer 74

aka saccular week 26-38 epithelium thins to become type I cells capillaries grown into developing respiratory areas blood air barrier forms type II cells appear surfactant reduces surface tension allowing expansion

Question 75

alveolar period

Answer 75

late fetal to childhood surfactant production increases gas exchange areas mature pulmonary and systemic circulation seperated alveoli mature from age 3-8, numbers increase

Question 76

respiratory distress syndrome

Answer 76

decreased levels of surfactant in alveoli usually due to prematurity damage to alveolar cells results in secretion of hyaline membrane

Question 77

pulmonary system is formed by what aortic arch

Answer 77

6th

Question 78

nose choanal atresia

Answer 78

congenital narrowing/obstruction of nasal passages bone or membrane can obstruct bilateral - extreme difficulty breathing, intubation may be required can have other congenital abnormalities may have feeding issues severe can need sx

Question 79

larynx laryngocele

Answer 79

acquired or laryngeal musicians bc increased pressure dilation of laryngeal saccule with communication with laryngeal lumen dyspnea, dysphagia, coughing, foreign body sensation respiratory epithelium overlying fibrous tissue may need sx

Question 80

neck thyroglossal duct cyst

Answer 80

from remnant of thyroid anlage as it descends in midline from tongie to low neck usually in children but can become symptomatic at any age asmptomatic subhyoid midline neck mass can be lined w stratifies squamous epithelium or pseudostratified columnar often enlarge after upper airway infection tx = sx malignant transformation can occur

Question 81

branchial cleft cysts

Answer 81

branchial cleft apparatus persists after fetal development several types, numbered according to their corresponding embryologic branchial cleft first = external auditory canal and parotid gland second/third = anterior border of SCM, second between internal and external carotids, third behind common carotid secondary infection occurs sx - remove cyst and fistula to point of origin SECOND MOST COMMON

Question 82

rhinitis

Answer 82

inflammatory conditions of nose and nasopharynx often viral nasal mucosa thickened, reddened usually self limited can be allergic

Question 83

sinonasal polyps

Answer 83

recurrent rhinitis mucosal focal protrusion edematous mucosa, loose stroma, hyperplastic/cystic mucous glands, mixed inflammatory cells can narrow airways and obstruct sinus drainage

Question 84

sinusitis

Answer 84

acute sinus infections often follow rhinitis can spread through bony floor of sinus organisms often normal flora in oral cavity inflammation nonspecific but can block outflow can develop chronic (fungal) can spread to orbit resulting in osteomyelitis or septic thrombophlebitis or dural sinus

Question 85

necrotizing lesions

Answer 85

granulomatosis with polyangitis (Wegners) acute fungal infections extranodal NK/Tcell lymphoma

Question 86

nasal septal perforation

Answer 86

trauma infections (TB, syphilis, leprosy) vegner granulomatosis lupus cocaine chronic dust exposure malignant tumors

Question 87

red flags for anosmia (loss of smell)

Answer 87

head injury neuro symptoms sudden onset covid

Question 88

epistaxis

Answer 88

nose bleeds usually anterior vessels that stop with direct pressure posterior vessels may need electrocautery drying of mucosa and nasal trauma causes bleeding disorders can cause

Question 89

tonsillitis/pharyngitis

Answer 89

viral upper respiratory infections

Question 90

diphtheria

Answer 90

corynebacterium diphtheriae respiratory droplet or skin exudate spread pharyngeal membrane develops inactivate EF2 toxin produced and released

Question 91

epiglottitis

Answer 91

hemophilus influenzae or beta hemolytic strep sudden swelling of epiglottis and vocal cords

Question 92

laryngitis

Answer 92

allergic or toxic exposure viral or bacterial infects infants and young children can have serious infections with laryngeal obstruction

Question 93

otitis externa

Answer 93

infection of external auditory ear canal swimming or trauma pseudomonas or staph

Question 94

otitis media

Answer 94

viral or secondary bacterial infects chronic disease can have repeated bouts cholesteatoma (cystic lesion with keratinizing squamous epithelium filled w keratin) can develop with chronic

Question 95

otosclerosis

Answer 95

abnormal deposition of bone in ears around rim of oval window many autosomal dominant

Question 96

nasopharyngeal carcinoma

Answer 96

malignant tumor resembles squamous cell carcinoma (keratinizing and nonkeratinizing) radiosensitive (nonkeratinizing more than keratinizing) primary tumors clinically occult for long periods EBV infects, hereditary, age, environment (smoking/chemicals) african children, southern china adults

Question 97

olfactory neuroblastoma

Answer 97

malignant neuroectodermal olfactory cells bimodal (peak 15 and 50) nasal obstruction and epistaxis small blue round cell neoplasm with fibrillary matrix w neural origin stain for enolase, synaptophysin, CD56, chromogranin, S100

Question 98

sinonasal papilloma

Answer 98

benign exophytic, endophytic (inverted), or cylindric (several layers of eosinophilic columnar cells) most common in adult males endophytic most aggressive (most have EGFR gene mutation) others often have HPV type 6 or 11

Question 99

nasopharyngeal angiofibroma

Answer 99

benign highly vascular with dense collagenous stroma red haired fair skinned adolescent males associated with familial adenomatous polyposis with mutations in CTNNB1 locally aggressive and intracranial extensions

Question 100

vocal cord nodules/polyps

Answer 100

singers node polyps unilateral, nodules bilateral smooth small, covered in simple squamous epithelium can become keratotic, hyperplastic, dysplastic can ulcerate if bilateral lesions touch voice changes

Question 101

squamous papilloma

Answer 101

benign neoplasm on vocal cords often single lesion in adults, multiple in children HPV type 6 and 11

Question 102

laryngeal carcinoma

Answer 102

premalignant changes (hyperplasia and dysplasia before malignant transformation) cigarette smoking/alcohol 95% squamous cell carcinoma can develop on vocal cords, above or below cords, epiglottis and aryepiglottic folds, pyriform sinuses 6th decade hoarseness, dysphagia, dysphonia tx = sx, radiation, chemo and radiation

Question 103

external ear tumors

Answer 103

skin cancers - often basal cell or squamous cell carcinoma on pinna

Question 104

inner ear tumors

Answer 104

schwannoma - bening, around CN VIII can causing hearing loss, dense areas (Antoni A) and loose areas (Antoni B), stain S100, bilateral can be NF2 meningioma - can arise from meninges surrounding CN VIII, benign, nests/whorls, calcifications, stain for EMA, can have deletions in chromosome 22

Question 105

neck tumors

Answer 105

paraganglioma/carotid body - neuroendocrine tumor, loss of function mutations, nests of round to oval tumor cells surrounded by fibrous stroma, stain for synaptophsin/chromogranin/CD56/CD57 familial autosomal inheritance of MEN-2

Question 106

anti-tussives

Answer 106

cough suppressant codeine hydrocodone dextromethorphan benzonatate

Question 107

codeine/hydrocodone

Answer 107

like opioids central suppressive action in medulla and peripheral effects contraindicated - MAO inhibitors (serotonergic potential) side effects - constipation, drowsiness, N/V, addictive potential

Question 108

dextromorphan

Answer 108

opioid derivative decrease sensitivity of cough receptors interrupt transmission of cough impulses by depressing medullary center through sigma receptor stimulation side effects - less constipation, serotonergic potential, may have hallucinogen effect at high doses

Question 109

benzonatate

Answer 109

glycerol derivative anesthesize scrathc receptors in respiratory passages, lungs, pleura dampening activity and reducing cough reflex onset 15-20 min, lasts 3-8 hours

Question 110

antihistamines

Answer 110

first gen - chlorpheniramine, diphenhydramine, hydroxyzine, promethazine second gen - fexofenadine, loratadine, cetirizine degranulation inhibitors - cromolyn, nedocromil H2 blockers - cimetidine, famotidine, ranitidine

Question 111

first gen antihistamines

Answer 111

competitive H1 receptor antagonist temporary relief of sneezing, watery eyes, itching eyes, runny nose side effects - sedation, anticholinergic effects interactions - CNS depressants, MAO inhibitors

Question 112

second gen antihistamines

Answer 112

selective peripheral H1 receptor antagonisst activity less sedation seasonal allergic rhinitis and uncomplicated chronic idiopathic purpura fexofinidine interacts w ketoxonazole and erythromycin cetirizine and loratadine preferred in pregnancy citirizine in pediatrics 6 months and older

Question 113

degranulation inhibitors

Answer 113

prevent degranulation of pulmonary mast cells and decrease release histamine, PAF, LTC4 allergen and exercise induced asthma side effects - throat irritation and bronchospasm

Question 114

decongestants

Answer 114

phenylephrine pseudoephedrine oxymetazoline

Question 115

phenylephrine

Answer 115

oral not effective as nasal decongestant alpha 1 selective agonist (vasoconstriction of respiratory mucosa) nasal spray = nasal decongestant systemically = BP ophthalmic = mydriasis contraindicated - HTN, centricular tachycardia, hypersensitivity side effects - headache, reflex bradycardia, excitability, restlessness, sensitivity to light, nose bleeds avoid when using MAO inhibitors

Question 116

pseudoephedrine

Answer 116

alpha and beta 2 agonist (vasoconstriction in mucosa, vasodilation in bronchi) increase drainage of sinus secretions, open eustachian ostia contraindicated - MAO inhibitors, HTN, enlarged prostates side effects - nervousness/insomnia

Question 117

oxymetazoline

Answer 117

long acting topical nasal decongestant direct acting alpha agonist temporary relief of nasal congestion and stuffiness contraindicated - MAO inhibitors side effects - Hypotension DONT TAKE LONGER THAN 3 DAYS

Question 118

mucolytics

Answer 118

dissolve thick mucus only inoatient use N-acetylcysteine dornase alpha

Question 119

n-acetylcysteine

Answer 119

break up thick mucous by opening disulfide bonds and reducing viscosity of mucous reduce congestion and treat acetominophen overdose

Question 120

dornase alpha

Answer 120

break down DNA and reduce thickness of fluids in lungs of patients with cystic fibrosis

Question 121

guaifenesin

Answer 121

exportorant signal body to increase amount or hydration of secretions more but clearer secretions aid in flow of respiratory secretions

Question 122

nystatin

Answer 122

magic mouthwash swish and swallow bind sterols in cell membrane of susceptible candida allowing leakage of intracellular components

Question 123

otitis media organisms

Answer 123

S. pneumoniae H. influenzae M. catarrhalis

Question 124

acute otitis media treatment

Answer 124

M - medicine to treat pain A - antibiotics O - observation

Question 125

medicine to improve pain

Answer 125

acetominophen ibuprofen (> 6 months) ear drops with numbing (auralgan) topical benzocaine, procaine, lidocaine (>2 years)

Question 126

antibiotics

Answer 126

<6 months give Abx 6 months - 2 years give Abx if certain diagnosis or uncertain dx w severe illness <60 days evaluated to rule out bacterial infection children over 2 with otalgia >48 hrs, temp >102.2 in past 48 hrs, bilaterall AOM or otorrhea, uncertain followup, appear toxic

Question 127

antibiotics with no recent betalactam, no concomitant prululent conjunctivitis, no recurrent AOM

Answer 127

amoxicillin

Question 128

antibiotics with recent beta lactam, concomitant purulent conjunctivitis, recurrent AOM

Answer 128

amoxicillin.clavulanate

Question 129

allergic to PCN but not type 1

Answer 129

"cef"

Question 130

type 1 allergy to PCN

Answer 130

azithromycin, clarithromycin, erythromycin, clindamycin, TMP/SMX

Question 131

antibiotic for recurrent AOM

Answer 131

less than 15 days of antibiotic completion - persistence of original organizm (ceftriaxone or levofloxacin) over 15 days after antibiotic completion - new organizm (amoxicillin/clavulanate) tympanostomy >3 distinct and well documented

Question 132

observation with initiating antibiotics if symptoms worsen or fail to improve in 48-72 hours if

Answer 132

over 2 years no otorrhea unilateral for <48 hours and temp < 102.2 otherwise healthy follow up in 48-72 hours

Question 133

follow up ear exam when

Answer 133

2-3 months after treatment

Question 134

otitis media with effusion

Answer 134

resolves without medical intervention primary management is watchful waiting or tympanostomy tubes

Question 135

sinusitis or rhinosinusitis

Answer 135

98% viral determine if viral or bacterial if viral, relieve symptoms if bacterial, watch or antibiotics

Question 136

symptomatic treatment

Answer 136

analgesics (acetominophen/ibuprofen) saline irrigation topical glucocorticoid (fluticasone/mometasone) intranasal decongestant (oxymetazoline) oral decongestant (pseudoephedrine) antihistamines mucolytics guafenesin

Question 137

bacterial sinusitis

Answer 137

uncomplicated and good follow up - watchful waiting antibiotics - resolve infection, prevent bacterial complications, avoid chronic sinus disease

Question 138

chronic sinusitis

Answer 138

antibiotics to treat acute exacerbations of chronic sinusitis same organisms but include staph and anaerobes (amoxicillin/clavulanate or clindamycin) topical intranasal corticosteroids saline irrigation

Question 139

allergic rhinitis

Answer 139

reduce exposure to triggers pharm therapy - nasal irrigation/saline sprays, intranasal glucorticoids, nasal antihistamines, oral antihistamines, nasal decongestant, oral decongestant, ipratropium/cromolyn/leukotriene modifiers allergen immunotherapy

Question 140

diphtheria

Answer 140

gram positive bacteria respiratory - antibiotics and diptheria antitoxin cutaneous - antibiotics only two negative cultures 24 hours apart before isolation can be discontinued erythromycin or penicillin prophylaxis for contacts - penicillin vaccine to avoid

Question 141

pharyngitis

Answer 141

most viral causes group A strep (penicillin) supportive - topical/local therapies, throat sprays, herbals, systemic analgesics, glucocorticoids

Question 142

mumps

Answer 142

only supportive therapy MMR vaccine

Question 143

development of face

Answer 143

between 4-8 weeks lower jaw forms first facial proportions develop in fetal period (9th week to birth)

Question 144

5 primordial prominences

Answer 144

develop around wee 4 neural crest mesenchyme around sstumodeum 1 - frontal nasa 2,3 - maxillary 4,5 - mandibular

Question 145

stumodeum

Answer 145

ectoderm lined depression between frontonasal prominences seperated from primitive endodermal pharynx by buccopharyngeal membrane buccal membrane degenerates in 4th week and stumodeum opens into pharynx forms vestibule of oral cavity

Question 146

nasal placodes

Answer 146

bilateral oval shaped ectodermal thickenings above lateral angles of stumodeum develop end of 4th week primordia of nose and nasal cavities

Question 147

nose is formed by what

Answer 147

the 5 facial prominences frontonasal = bridge medial nasal prominences = crest and tip lateral nasal prominences = sides

Question 148

frontonasal process

Answer 148

nasal placodes lie in floor of depression called nasal pits nasal pit surrounded by mesenchymal swellings swellings are medial and lateral nasal prominences medial = forehead, middle of nose and nasal septum, philtrum of upper lip, premaxilla

Question 149

maxillary processes

Answer 149

grow ventrally and medially compress medial nasal folds toward midline and convert them into 1 medial nasal fold separated from lateral nasal folds by nasolacrimal groove lower part of groove develop nasolacrimal duct and pper part lacrimal sac laterally merge w mandibular processes to form cheek medially fuse to form upper lip palatine shelf develops from medial sufaces

Question 150

mandibular processes

Answer 150

lower jaw lower lip floor of mouth

Question 151

nasal cavity

Answer 151

end of 6th week nasal pits deepen and form nasal sacs nasal sac grows dorsocaudally ventral to developing brain initially seperated from oral cavity by oronasal membrane which ruptures at 7th week these communications are primitive choanae located posterior to primary palate after development of secondary palate choanae change position and become located at junction of nasal cavity and pharynx

Question 152

nasal septum

Answer 152

forms from downward growth from iner parts of fused medial nasal prominences fuses with palatine process between 9 and 12 weeks superior to prmordium of hard palate

Question 153

lateral wall

Answer 153

superior, middle, inferior conchae develope

Question 154

paranasal air sinuses

Answer 154

develop after birth (except maxillary sinus) develop as diverticula of lateral nasal wall extend into maxilla, ethmoid, frontal, and sphenoid bones reach max during puberty

Question 155

facial clefts

Answer 155

difficulty breathing, feeding, sucking, swallowing, speech

Question 156

otitis media - steptococcus pneumoniase

Answer 156

lancet shaped gram positive diplococci alpha hemolytic leading cause of bacterial pneumonias antiphagocytic capsule optochin sensitive lysed by bile reservoir human upper respiratory tract transmission respiratory droplets history of upper respiratory viral infection vaccine - polysaccharide, do not induce t cell dependent response, high risk groups (old, < 2 years, chronic disorders)

Question 157

otitis media - haemophilus influenzae

Answer 157

small gram negative rods (coccobacillus) X (porphyrin) and V (NAD) factors required in blood virulence factor - antiphagocytic capsule, 6 capsule types transmitted via respiratory droplets first colonize nasopharynx and spread through eustachian tube tx - TMP/SMX or augmentin children under 2 most at risk

Question 158

otitis media - moraxella catarrhalis

Answer 158

gram negative diplococcus oxidase positive normal upper respiratory tract flora transmission respiratory droplets endotoxin may play role in disease otitis media and sinusitis - both secondary to viral upper respiratory infection

Question 159

otitis externa - pseudomonas aeruginosa

Answer 159

gram negative rod oxidase positive opportunistic spread via water

Question 160

naegleria fowleri

Answer 160

ameboflagellate flagellate stage is infectious stage warm brackish water primary amebic meningoencephalitis after swimming gain access to CNS - via nasal cavity pass through olfactory epithelium and cribiform plate multiple discrete focal hyperintense lesiosn at corticomedullary junctions, basal ganglia, and midbrain

Question 161

pharyngitis - group A strep (pyrogenes)

Answer 161

hyaluronic acid capsule, group A carbohydrate, M protein tonsillitis beta hemolytic cannot be diagnosed by clinical symptoms, diagnosis important to prevent rheumatic fever primary disease 4-10 days and remits spontaneously tx - penicillin

Question 162

pharyngitis - viridans strep

Answer 162

gram positive cocci alpha hemolytic resistant to optochin dental carries

Question 163

neisseria

Answer 163

gram negative cocci nonpathogenic species inhabit respiratory tract as normal flora cultured on chocolate agar or thayer martin superoxol - positive = N. gonorrhea oral gonorrhea - oral sex/kissing affected individual, sore throat w patchy exudate

Question 164

pharyngitis - corynebacterium diptheriae

Answer 164

club shaped non acid fast unencapsulated non-motile gram positive bacillus produce exotoxin loefflers coagulated serum medium for culture often joined at right angles forming v's or L's virulence factors - diphtherial cord factor, diphteria toxin (classic A/B toxin) elek test - white line appears means its toxigenic spread via respiratory droplets high fever, sore throat, edema of tissues beneath membrane (bull neck), myocarditis, neurologic symptoms, nephritis active immunization - given at birth and booster after 7 years, get booster if exposed

Question 165

pharyngitis - actinomyces israelii

Answer 165

anaerobic gram positive branching rods non acid fast endogenous transmission invasive growth in tissues with compromised oxygen supply, typically abcess formation tissue swelling and draining abcess with sulfur granules cervicofacial pelic tx - ampicillin/penicillin

Question 166

rhinitis

Answer 166

common cold rhino adeno/corono coxsackie

Question 167

rhinitis - picornaviridae

Answer 167

positive ssRNA capsid composed of 3 viral proteins no envelope (fecal/oral route)

Question 168

rhinitis - coxsackievirus

Answer 168

mouth portal of entry replicate in oropharynx and intestine incubation 1-2 weeks A16 = hand, foot, mouth sore throat/mouth with lesions on hands and feet, usually lasts 1 week herpangia - A, posterior portion of mouth on soft palate and uvula vesicular lesions

Question 169

rhinitis - rhinoviruses

Answer 169

mild self limiting disease of upper respiratory tract 115 serotypes (geographically specific) acid labile and cant pass through stomach nonenveloped transmitteed w respiratory objects, contact w contaminated objects RNA viruses - undergo antigenic drift virus attaches to ciliated epithelial cells interferon release during inflammatory response can increase ICAM 1 (which virus attaches)

Question 170

rhinitis - adenoviridae

Answer 170

non enveloped double stranded lindear DNA genome fecal/oral and respiratory aerosol route can establish persistent infections vaccines available but not routine self limiting

Question 171

coronaviridae

Answer 171

mild infection spherical RNA viruses nucleocapsid is helical enveloped transmision via respiratory aerosolized droplets immunity strain specific and short lived replicates locally in ciliated epithelium of upper respiratory tract acute upper respiratory infections

Question 172

pharyngitis - paramyxovirus

Answer 172

non segmented negative ssRNA helical nucleocapsid enveloped two viral peplomers - F protein, HN protein parainfluenza virus types 1 and 3 - croup pneumonia and bronchiolitis (type 3) upper respiratory infections (type 4) infect respiratory epithelium, spread cell to cell in nose and pharynx supportive care (maintain airway)

Question 173

rhinitis - rubulavirus

Answer 173

mumps trivial childhood disease salivary gland secretions transmission systemic generalized infection spread by viremia involve glandular and nervous tissue parotid gland, salivary glands, testes, ovaries, pancreas, brain benign and self limiting complications - orchitis (inflammed testis), meningitis and encephalitis, pancreatitis supportive care vaccine - live attenuated

Question 174

eyes - adenoviridae

Answer 174

pharyngoconjunctival fever swimmers eye pink eye conjunctivitis in nonpurulent self limiting keratoconjunctivitis - 2 types sporadic acute follicular conjunctivitis (benign, similar to PCF without sore throat) epidemic keratoconjunctivitis - highly contagious, acute watery discharge and foreign body sensation, spread to both eyes, pseudomembrane

Question 175

eyes - neisseria gonorrhea

Answer 175

baby birthed to infected mother may develop corneal ulcerations causing lens to be extruded untreated will cause blindness

Question 176

eyes - loa loa

Answer 176

african eye worm bite of mango fly migrate extensively may have allergic reaction to worms tx - diethylcarbamazine, corticosteroids, concjunctival worms (cocaine solution and sx)

Question 177

eyes - pseudomonas aeruginosa

Answer 177

fulminating ulceration of cornea (keratitis) destroys eyes

Question 178

what drives O2 and CO2 movement

Answer 178

diffusion concentration gradient is the driving force

Question 179

ficks law of diffusion

Answer 179

diffusion = k x A x (P2-P1)/D

Question 180

air moves from what

Answer 180

high pressure to low pressure

Question 181

for inspiration to occur what must happen

Answer 181

pressure difference must be established no pressure difference, no airflow

Question 182

intrapleural pressure

Answer 182

aka intrathoracic pressure aka pleural pressure pressure in thin space between visceral and parietal pleura always less than atmospheric gradient from apex to base

Question 183

pneumothorax

Answer 183

atmospheric air enters thorax raises intrapleural pressure dyspnea, uneven chest expansion, chest pain, hyperresonance, diminished breath sounds

Question 184

intrapulmonary pressure

Answer 184

aka alveolar pressure equal to atmospheric pressure at rest

Question 185

transpulmonary pressure

Answer 185

difference between alveolar and intrapleural pressure in the lung

Question 186

how is pressure gradient created

Answer 186

increased lung volume: decreases intrapulmonary lung pressure, air moves into lung (inspiration) negative pressure breathing - lowering alveolar pressure below atmospheric decrease lung volume - increase intrapulmonary lung pressure, air moves out (expiration)

Question 187

at rest

Answer 187

intrapleural pressure subatmospheric intrapulmonary pressure equal to atmospheric pressure

Question 188

inspiration

Answer 188

decrease in intrapulmonary and intrapleural pressure alveoli pulled open increasing volume

Question 189

expiration

Answer 189

increase in intrapulmonary and intrapleural pressure decrease volume of alveoli

Question 190

muscles of inspiration

Answer 190

diaphragm external intercostals accessory (not in quiet breathing) - elevate sternum, SCM, trap, vertebral muscles

Question 191

expiratory muscles

Answer 191

passive in quiet breathing abdominal muscles internal intercostals

Question 192

pressure volume curve

Answer 192

transpulmonary pressure increases, lung volume increases slope = compliance

Question 193

total lung compliance

Answer 193

compliance of lung + compliance of chest wall right shift = less compliance left shift = more compliant

Question 194

elastic properties of the lung

Answer 194

elastin - compliant and distensible, important at low and normal volumes collagen - less compliant and less distensible, important at higher volumes surface tension - air liquid interface in alveoli

Question 195

laplaces law

Answer 195

pressure = 2 x tension / radius tension = pressure x radius / 2

Question 196

pulmonary surfactant

Answer 196

decrease surface tension increase lung compliance stabilize alveoli (lower surface tension of smaller alveoli to equilize pressure inside alveoli of different sizes)

Question 197

airway resistance

Answer 197

elastic recoil of lung elastic recoil of chest wall frictional resistance of lung and chest wall tissue frictional resistance of airways to air flow

Question 198

tissue resistance

Answer 198

friction encountered as lung tissues move against each other or chest wall

Question 199

airway resistance

Answer 199

resistance to flow of gases during ventilation resulting from obstruction or turbulent flow

Question 200

increase pulmonary tissue resistance

Answer 200

sarcoidosis silicosis asbestosis fibrosis

Question 201

flow

Answer 201

flow = pressure gradient / resistance resistance increases with decrease in radius pressure difference = flow x resistance

Question 202

when does turbulent flow occur

Answer 202

reynolds number over 3000

Question 203

transitional flow

Answer 203

branching points (bronchial tree)

Question 204

laminar flow

Answer 204

small airways

Question 205

turbulent flow

Answer 205

trachea

Question 206

distribution of airway resistance

Answer 206

50% in upper airways resistance higher when breathing through nose small airways in parrallel to decrease resistance large and medium bronchi have greatest resistance

Question 207

parasympathetic

Answer 207

vagus nerve release ACh causing bronchoconstriction increase airway resistance

Question 208

sympathetic

Answer 208

NE dilates bronchi and bronchioles weak effect

Question 209

humoral factors

Answer 209

epinephrine - bronchodilator histamine - constrict bronchioles and alveolar ducts leuktrienes - bronchoconstrictor

Question 210

airway resistance decreases with what

Answer 210

increased lung volume (small airways distended increasing radius, traction of small airways decrease resistance bc interdependent)

Question 211

traction of smll airways decrease airway resistance

Answer 211

small airways attached to alveoli, as alveoli expand during inspiration small airways also expand

Question 212

acute bacterial sinusitis in children and adolescents common causes

Answer 212

S. pneumoniae H. influenzae M. catarrhalis

Question 213

predisposing factors to sinusitis

Answer 213

viral upper respiratory infection allergic rhinitis tobacco smoke exposure immune deficiencies nasal polyps

Question 214

3 key factors to sinusitis

Answer 214

obstruction of sinus ostia dysfunction of ciliary apparatus thickening of sinus excretions

Question 215

sinusitis pathogenesis

Answer 215

narrow ostia allow obstruction viral URI most common cause of obstruction cause transient increase in pressure, oxygen depletes, pressure becomes negative letting bacteria enter from nose and pharynx

Question 216

bacterial diagnosis

Answer 216

based on history persistent nasal discharge > 10 days without improving severe symptoms including temp of 102 purulent nasal discharge > 3-4 days

Question 217

chronic sinusitis

Answer 217

persistent respiratory symptoms > 90 days

Question 218

tx bacterial sinusitis in children

Answer 218

amoxicillin

Question 219

sinusitis complications

Answer 219

meningitis, subdural empyema, epidural empyema, brain abcess, venous sinus thrombosis optic neuritis, orbital cellulitis, orbital abcess, subperiosteal abcess, periorbital cellulitis

Question 220

nasopharyngitis

Answer 220

common cold over 200 viruses treatment supportive

Question 221

pharyngitis

Answer 221

most causes viral important to rule out group A strep tx - oral antipyretic/analgesic, topical anesthetic

Question 222

group A strep

Answer 222

sudden onset, fever, headache, nausea, vomiting, abdominal pain, patchy exudates, palatal petechiae, anterior cervical adenitis, scarlatiniform rash tx - amoxicillin preferred in children

Question 223

rapid strep test

Answer 223

highly specific and sensitive negative test should always be confirmed with throat culture

Question 224

peritonsillar abcess

Answer 224

often >10 years fever, dysphagia, hot potato or muffled voice, drooling, unilateral swelling, deviation of uvula to contralateral side

Question 225

retropharyngeal and lateral pharyngeal abcess

Answer 225

< 4 years usually males > females often recent hx ear, nose, or throat infection fever, irritability, drooling, neck stiffness, torticolis, mufled voice, stridor complications - upper airway obstruction, aspiration pneumonia, extension to mediastinum, thrombophlebitis of internal jugular vein

Question 226

lemierre disease

Answer 226

infection from oropharynx causing septic thrombophlebitis of internal jugular vein and embolic abacess in lungs acutely ill with fever, hypoxia, tachypnea, respiratory distress cause septic shock lesions are necrotic cavitary tx - broad spectrum antibiotics

Question 227

herpangia

Answer 227

fever, throat pain, lesions of posterior pharynx coxsackie viruses tx - supportive, pain control, monitor for dehydration

Question 228

herpetic gingivostomatitis

Answer 228

HSV 1 initial fever, malaise gingiva etythematous, mucosal hemorrhages and clusters of vesicles often extending to periorbital skin acyclovir if given in first 3 days

Question 229

kawasaki disease

Answer 229

acute, self limited, acquired inflammatory disorder vasculitis of small vessels can lead to coronary artery aneurysm diagnosis: fever for 5+ days and 4 of the following -rash -oropharyngeal membrane changes -conjunctival injection -extremity changes -lymphadenopathy

Question 230

periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis (PFAPA) syndrome

Answer 230

recurrent fever syndrome not autoimmune diagnosis of exclusion episodic tx - single dose glucocorticoid at onset of fever daily tx - colchicine and cimetidine tonsillectomy - usually resolves

Question 231

infectious mononucleosis

Answer 231

EBV fatigue, malaise, fever, sore throat, lymphadenopathy transmitted by oral secretions primary infection in childhood results in asymptomatic or mild illness incubation in adolescents 30-50 days spleen enlargement

Question 232

tonsilar lymphoma

Answer 232

asymmetrically enlarged tonsil without evidence of infection

Question 233

burkitt leukemia

Answer 233

burkitt lymphoma with prevalence of malignant burkitt cells in bone marrow rapid expanding soft tissue masses considered in cases of rapid tonsillar enlargement or prominent ipsilateral cervical lymphadenopathy

Question 234

cerumen and removal

Answer 234

usually expelled with normal jaw movements but self cleaning fails in some people removal - curette, irrigation must be very cooperative or well restrained

Question 235

mastoiditis

Answer 235

displacement of pinna away from skill midle ear infection, erythema, edema, exquisite tenderness palpating mastoid process, purulent otorrhea

Question 236

also displacing pinna away from head

Answer 236

primary cellulitis of periauricular tissue (skin lesions to distinguish) edema from insect bites contact dermatitis basilar skull fractures

Question 237

tympanic erythema can be caused by what

Answer 237

crying of little diagnostic value

Question 238

flow is proportional to difference in partial pressures

Answer 238

Vnet = DL x (P1-P2) DL = diffusing capacity for lung DL = (A x D x (P1-P2))/T

Question 239

thicker the barrier is

Answer 239

smaller the O2 partial pressure gradient

Question 240

inspiration

Answer 240

increase surface area increase PAO2 decrease thickness

Question 241

PCO2

Answer 241

pulmonary artery O2 max at the begining of the pulmonary capillary gradually falls to zero further along capillary

Question 242

diffusion limitation

Answer 242

diffusing capacity limits transport of gas gas doesnt reach diffusion equilibrium end capillary pressure fails to reach alveolar partial pressure

Question 243

perfusion limitation

Answer 243

blood flow through pulmonary capillaries limits gas exchange across alveolar capillary barrier gas in capillary comes into equilibrium with the gas in the alveolar air by end of capillary

Question 244

exercise

Answer 244

diffusion limited because increase in cardiac output O2 doesnt stay in capillaries long so end capillary pressure doesnt increase like it does at rest

Question 245

high altitude

Answer 245

PO2 decreased perfusion limited at rest diffusion limited upon exertion

Question 246

measuring diffusion capacity

Answer 246

steady state - measure Vco and Paco (DLco = Vco/Paco) single breath - max exhale, max inspiration, hold breathe for 10 sec, measure Paco and Vco to estimate DLco

Question 247

diffusing capacity decreases with

Answer 247

thickening of alveolar blood gas barrier surface area reduction decrease Hb (diffuse interstitial pulmonary fibrosis, COPD, loss of functional lung tissue, anemia)

Question 248

Hb without O2

Answer 248

tense, iron pulled out of ring

Question 249

HB with O2

Answer 249

relaxed, iron moves into plane

Question 250

factors increasing O2 dissociation

Answer 250

increased hydrogen ions (decreased pH) increased 2,3 bisphosphoglycerate covalent binding CO2

Question 251

carbon monoxide

Answer 251

competes with O2 for binding higher affinity

Question 252

alternate route for CO2

Answer 252

CO2 binds Hb form carbamate reversed in lungs OR carbonic anhydrase in RBC conver CO2 into bicarbonate and hydrogen reversed in lungs

Question 253

spirometry

Answer 253

measures changes in lung volumes can measure lung resistance

Question 254

tidal volume

Answer 254

volume of air entering or leaving in one breath

Question 255

inspiratory reserve volume

Answer 255

volume of gas inhaled during max forced inspiration starting at end of normal tidal inspiration

Question 256

IRV/ERV affected by

Answer 256

decreased by greater lung volumes after inspiration decreased by decreased compliance decreased by weakened muscles decreased with pain decreased with decreased skeletal flexibility decreased w posture changes

Question 257

expiratory reserve volume

Answer 257

volume of gas expelled during max exhale that starts at end of normal tidal exhale

Question 258

residual volume

Answer 258

volume of gas left in lungs after max forced exhalation determined by elastic recoil and expiratory muscles prevents lungs from collapsing at low volumes

Question 259

total lung capacity

Answer 259

volume in lungs after max inhalation

Question 260

functional residual capasity

Answer 260

volume of gas remaining in lungs at end of normal tidal respiration

Question 261

inspiratory capacity

Answer 261

colume of air inhaled into lungs during max inhalatory effort begining at end of normal tidal expiration

Question 262

vital capacity

Answer 262

volume of air expelled from lungs during max forced expiration starting after max forced inspiration

Question 263

restricitve lung disease

Answer 263

reduced compliance causing reduced volumes decrease FRC, TLC, VC, IRV, ERV and maybe RV/Vt

Question 264

obstructive lung disease

Answer 264

increased resistance to airflow increase RV, FRC, TLC

Question 265

FEV1/FVC

Answer 265

forced expiratory volume in one second/forced vital capacity indirectly assesses expiratory airway resistance normal is 0.8 or 80%

Question 266

flow volume curve

Answer 266

expiration effort dependent and effort independent (lower lung volumes) no effort independence for inspiration obstructive - flow rate lower than normal, high total volumes restrictive - low volumes, flow rate lower than normal

Question 267

control of breathing

Answer 267

CNS initiates no conscious effort

Question 268

reflex responses can modify breathing cycle

Answer 268

respiratory activity matched to metabolic demand and other activity like exercise, speech, holding breath voluntary paths can go directly from higher centers to respiratory muscles

Question 269

respiratory centers

Answer 269

reticular formation of medulla (medullary respiratory centers)

Question 270

dorsal respiratory group

Answer 270

inspiratory neurons initiate phrenic nerve and maintain diaphragmatic activity integrate cardiopulmonary reflexes

Question 271

ventral respiratory group

Answer 271

inspiratory and expiratory neurons innervate intercostals and abdominal muscles and auxiliary muscles

Question 272

respiratory reflexes

Answer 272

sensors in lungs, cardiovascular system, muscles, tendons, skin, viscera elicit alterations in breathing stimuli from lung inflation, lung deflation, mechanical/chemical irritation, changes in O2/CO2, stretch receptors, blood pressure

Question 273

rise in CO2

Answer 273

increase alveolar ventilation sleep, drugs, chronic obstruction can depress ventilatory response to CO2

Question 274

increase in H ions

Answer 274

increase pulmonary ventilation

Question 275

hypoxia response

Answer 275

increase alveolar ventilation

Question 276

exercise

Answer 276

increase oxygen consumption and CO2 production stimulates ventilation phase I - immediate increase in ventilation phase II - slow increase in ventilation as exercise continues phase II - if not too rigorous ventilation reaches steady state

Question 277

hypersensitivity

Answer 277

failure of immune system requires sensitization and is antigen specific

Question 278

type I hypersensitivity

Answer 278

immegiate IgE mediates IgE secreted from plasma and binds FcR on mast cells/basophils, exposure cross links mast cells and causes degranulation

Question 279

type II hypersensitivity

Answer 279

cytotoxic IgG and IgM mediated antibodies bind cells or tissues cytotoxic = direct lysis of red blood cells, rheumatic fever non cytotoxic = cell or tissue altered in function

Question 280

type III hypersensitivity

Answer 280

immune complexes IgG and IgM mediated immune complexes mediated destruction of tissues systemic no organ specific serum sickness hypersensitivity pneumonitis lupus

Question 281

type IV hypersensitivity

Answer 281

delayed T cell (48 hrs) TB skin test TH1 response

Question 282

hypersensitivity basics

Answer 282

first contact = no response but get sensitized reexposure = reaction (repeated can increase or decrease severity)

Question 283

mast cells

Answer 283

mucosa and epithelial surfaces all vascularized tissues contain granules w pharmacologically active mediators

Question 284

atopic person

Answer 284

genetic defect affecting regulation of IgE resonse non parasitic antigens stimulate inappropriate IgE production allergic rhinitis, asthma, atopic dermatitis mutations in IL4, TCR, IgE, MHCII

Question 285

african american children have higher rate of what

Answer 285

asthma

Question 286

hispanic children have higher rate of what

Answer 286

eczema

Question 287

environmental risk factors for allergies

Answer 287

lack of pathogen exposure, C section vs vaginal birth, overuse of antibiotics, pollution, allergen levels, dietary changes

Question 288

allergens

Answer 288

small proteins dried up but rehydrate when inhaled presented by APCs to TH cells develop TH2 response to increase IgE

Question 289

allergic response

Answer 289

immediate - degranulation of mast cells late - secretion of synthesized products, recruitment of other granulocytes

Question 290

whats in the granules?

Answer 290

histamine - vascular permiability, smooth muscle contraction heparin - anticoagulant eosinophil chemotactic factor - chemotactic prostoglandin D2/E2/F2 - smooth muscle contraction, vascular permeability leukotriene C4/D4/E4 - smooth muscle contraction, vascular permeability leukotriene B4 - chemotactic for neutrophils

Question 291

asthma

Answer 291

bronchoconstriction extrinsic - allergens intrinsic - exercise, stress, viral infect Leukotriene C/D/E, acetylcholine, histamine, prostoglandin D, platelet activating factor, IL 1/6/TNF alpha

Question 292

systemic anaphylaxis

Answer 292

allergen enters blood affects many organs increase vascular permeability and contraction of smooth muscle leading to anaphylactic shock most commonly penicillin, insect stings, nuts tx - epinephrine

Question 293

organ specific anaphylaxis

Answer 293

allergens affect target organs most common respiratory, GI, connective tissues

Question 294

penicillin hypersensitivity

Answer 294

penicllin modify proteins present on RBCs making new antigen that isnt recognized by self new antigen presented and adaptive immune response generated type II = cells directly lysed type III = serum sickness

Question 295

TH1 mediated CD4 cytokine production

Answer 295

celiac disease TB test multiple sclerosis

Question 296

TH2 mediated CD4 cytokine production

Answer 296

chronic asthma

Question 297

cytotoxic CD8 t cell mediated

Answer 297

type I diabetes

Question 298

CD4 and CD8 t cell mediated

Answer 298

poison ivy